What Is an Infundibulopelvic Ligament?

The pelvis (pelvis) is a bony connection between the trunk and lower limbs, and is an important structure that supports the trunk and protects the pelvic organs. Female pelvis (female pelvis) is the bony birth canal that must pass through when the fetus is delivered. Its size and shape are closely related to the delivery. Abnormal pelvic morphology and the components of the interosseous lines can lead to abnormal childbirth. Usually the female pelvis is wider and shallower than the male pelvis, which is conducive to fetal delivery.

Female pelvis

(A) the bones of the pelvis

The pelvis is formed by the ossacrum, os coccyx, the left and right hip bones (os coxae) and their ligaments. Each hip bone is an irregular bone composed of the ossium (os ilium), the ischium (os ischium) and the pubic bone (os pubis). The sacrum is triangular in shape, the anterior depression is called the iliac fossa, and the middle leading edge of the base of the triangle protrudes to form the promotory (equivalent to the level of the common iliac bifurcation). The promontory is one of the important signs of gynecological laparoscopic surgery and an important base for measuring the diagonal diameter in the obstetric pelvis.

(B) the joints of the pelvis

1. Pubic symphysis: Fibrocartilage connection between two pubic bones.

The pelvis is divided into upper and lower parts by the line connecting the upper edge of the pubic symphysis, the zygomatic ray line, and the upper edge of the yin point.

According to the shape of the pelvis, female pelvis is divided into 4 types:

1. Female type (gynecoid type): The pelvic entrance is horizontally oval, and the transverse diameter of the entrance is slightly longer than the anterior and posterior diameters. The pelvic wall is straight. The sciatic spine is not prominent, the pubic arch is wide, and the diameter of the sciatic spine is 10cm. It is the most common female pelvis. Chinese women account for 52-58.9%.

2. Flat type (playtypelloid type): The entrance of the pelvic bone is oblong, the transverse diameter of the entrance is larger than the anterior and posterior diameters, the side wall of the pelvis is straight, the pubic arch is wide, the sacrum loses its normal curvature, and becomes straight backwards or deep curved, so Superficial pelvis, which is more common, is about 23.2% -29% of women in China.

3. Anthropoid type: The entrance of the pelvic bone is oblong, the front and rear diameter of the entrance is greater than the transverse diameter, the two sides of the pelvic bone are slightly cohesive, the ischial spine is more prominent, the ischial notch is wider, the pubic arch is narrow, and the sacrum Tilt backwards, so the front of the pelvis is narrower and the back is wider. The metatarsal bones often have 6 knots. The ape-like pelvis is deeper than other types. Chinese women account for about 14.2% -18%.

4. Male type (android type): The pelvic entrance is slightly triangular, the two side walls are cohesive, the ischial spine protrudes, and the pubic arch is narrow. The ischial notch is narrow and high arched, with the sacrum straight and leaning forward, resulting in a short posterior sagittal diameter. The pelvic cavity is funnel-shaped and often causes dystocia. Rarely, women account for only 1-3.7%

Female pelvis is fetus

The pelvic cavity is a curved cylindrical tube with a short front and a long back.

The pelvic diameter is too short or the shape is abnormal, causing the pelvic cavity to be smaller than the limit of the exposed part of the fetus. The narrow pelvis can be too short in one radial line or too short in multiple radial lines, or narrow in one plane or multiple planes at the same time. When a radial line is narrow, the size of other radial lines in the same plane should be observed, and the size and shape of the entire pelvis should be comprehensively analyzed to make a correct judgment.

(I) Narrow pelvic entrance plane is common in Chinese women. Measure the external diameter of the shame <18cm, the anteroposterior diameter of the pelvic entrance <10cm, and the diagonal diameter <11.5cm. There are two common situations:

1. Simple flat pelvis:

The pelvic entrance is horizontally flat and round, with the protuberance protrudes forward and downward, which shortens the anteroposterior diameter of the pelvic entrance and the transverse diameter is normal.

2. Rickety flat pelvis: deformed pelvis due to childhood softening of rickets,

The prongs were pushed forward, the anteroposterior diameter of the pelvic entrance was significantly shortened, making the pelvic entrance a kidney-shaped, the lower part of the sacrum moved backwards, lost the normal curvature of the sacrum, and turned straight backward. The coccyx protrudes toward the pelvic exit plane. Due to the sacral abduction, the intersacral spine diameter is equal to or greater than the intersacral diameter; due to the ischial tuberosity valgus, the pubic arch angle is increased and the pelvic outlet transverse diameter is widened.

(2) Narrow pelvic and pelvic exit plane narrow

1. Funnel shaped pelvis: The values of the pelvis entrance are normal.

Because both sides of the pelvic wall slope inward and look like a funnel, it is called a funnel pelvis. The characteristic is that the middle pelvic and pelvic exit planes are both significantly narrow, which shortens the diameter of the ischial spine and the diameter of the ischial tuberosity, and the angle of the pubic arch is <90 °. The sum of the diameter of the ischial tuberosity and the sagittal diameter after exit is less than 15cm, which is common in male pelvis.

2. Transversely contracted pelvis: with ape-like pelvis

Similarly, the lateral diameters of the pelvic inlet, middle pelvis, and pelvic outlet are shortened, the anterior-posterior diameter is slightly longer, and the ischial notch is wide. The measured external diameter of the zygomatic shame is normal, but the interspinous diameter and intersacral diameter are shortened.

(Three) narrow pelvic plane

The shape of the pelvis is a female pelvis,

However, the planes of the pelvic entrance, middle pelvis and pelvic exit are narrow, and the diameter of each plane is less than the normal value of 2 cm or more, which is called generally contracted pelvis. It is more common in women with short stature and shape.

(D) deformed pelvis

The pelvis loses its normal shape. There are two main types:

1. Osteomalacic pelvis: now rare. Due to lack of calcium, phosphorus, vitamin D, and insufficient ultraviolet radiation, bone mineralization disorders in adulthood are replaced by bone-like tissue, and bone is decalcified, loosened, and softened. Due to the torso gravity and the two femoral bones being squeezed inward and upward, the prosthesis protrudes forward, the pubic symphysis protrudes forward, the pelvic entrance plane is concavely triangular, the intertrochanteric diameter and the ischial tubercle diameter are significantly shortened. Accommodates 2 fingers.

2. Obliquely contracted pelvis: dysplasia of one side of sacral wing and hip bone

The resulting sacroiliac joint fixation, as well as lower limb and hip joint diseases, cause a skewed pelvis with a shortened oblique diameter on one side of the pelvis.

Pelvic axis

Pelvic axis: The curve connecting the midpoints of the imaginary planes of the pelvis. The upper section of this axis goes down, the middle section goes down, and the lower section goes down. The fetus is delivered along this axis during delivery.

Pelvic tilt

When the human body is upright, the upper pelvic plane is inclined forward and downward, and the anterior superior iliac spine and pubic tubercle on both sides are in

On a coronal plane, the tip of the coccyx and the upper edge of the pubic bone are on a horizontal plane. The angle formed between the upper pelvic plane and the ground plane is called the incline pelvic, and is about 50 to 55 °. Women are slightly more inclined than men.

Pelvic floor

The pelvic floor consists of three layers of muscle and fascia, which close the pelvic outlet and carry and support the organs in the pelvic cavity.

(1) The outer layer is composed of the superficial perineal fascia and muscles, including the superficial perineal muscle, bulbocavernosus muscle, ischiocavernosus muscle and external anal sphincter. All meet at the vagina and the anus, forming the perineal central tendon.

(2) The middle layer is the urogenital diaphragm, covering the triangular plane in front of the pelvic outlet formed between the pubic arch and the two ischial tuberosities. Including deep perineal muscles and urethral sphincter.

(3) The inner layer is called the pelvic iliac crest, which is composed of the levator ani muscle and the pelvic fascia and is penetrated by the urethra, vagina and rectum.

Soft tissue of pelvic wall and pelvic floor

(1) The pelvic wall muscle includes 4 pairs of obturator internal muscle, piriformis, levator anus, and coccyx.

(2) Pelvic fascia Pelvic fascia is a direct continuation of intra-abdominal fascia, which can be divided into pelvic fascia wall layer, pelvic fascia fascia, and pelvic fascia viscera.

(3) Pelvic fascia space and pelvic peritoneal depression. Extracellular peritoneal tissue forms some honeycomb tissue spaces between the pelvic floor peritoneum and the pelvic iliac crests, which are mainly: retropubic space; pelvic rectal space;

(4) The pelvic floor is composed of multiple layers of muscles and fascia, which close the pelvic outlet, through which the urethra, vagina and rectum pass. The pelvic floor carries pelvic organs and maintains their normal position. There are three layers of pelvic floor muscles, namely the outer layer, the middle layer (urogenital ridge) and the inner layer (pelvic ridge).

Pelvis and childbirth

The female pelvis is an important part of the birth canal, and the only way for the fetus to pass through the vagina.

Its size and shape directly affect childbirth. The upper part of a woman's pelvis is wide and has little to do with childbirth (the obstetric is called a pseudopelvis); while the lower part is very closely related to childbirth (called the true pelvis). The true pelvis is divided into three planes according to its relationship with childbirth, namely the entrance, middle cavity and exit planes. These three planes are all relatively narrow parts, and the fetus can be resisted during delivery, especially the middle pelvic plane is the narrowest part. The size and shape of the pelvis have a great influence on the difficulty of childbirth. It, together with the fertility and the fetus, constitute the three elements of childbirth. Normal pelvis, such as fertility and fetal abnormalities, the fetus is easy to give birth. With a noticeably narrow pelvis, a living fetus cannot give birth at all. The relatively narrow pelvis often depends on the fetus and fertility. If the female pelvis is anatomically wide and shallow, it will facilitate the passage of the fetus. But not all women have this shape. Some developmental variations, similar to the male pelvis, that is, the pelvis is deep and narrow, the anteroposterior diameter of the pelvis is relatively long, and the transverse diameter is relatively short, the fetus is not easy to give birth. Some pelvis are flat,

The entrance is short in front and back, and the fetus cannot pass through the pelvic population. However, some pelvis entrances are normal, and the middle and lower planes are becoming narrower and narrower, known as the funnel pelvis, which can also cause dystocia. In some cases, abnormal bones and joints can also cause abnormal pelvic shapes, such as rickets (osteomalacia) caused by calcium deficiency, which can cause severe deformation of the pelvis, and the fetus cannot deliver from the vagina at all. Occasional trauma causes pelvic fractures and deformities in the future, which may cause dystocia during delivery. Unless there is obvious deformity, the size of the pelvis cannot be accurately judged from the shape alone. Therefore, women must do an antenatal check-up after pregnancy, and measure the size of the pelvis at 34 to 36 weeks of pregnancy to determine the delivery method.

Impact of narrow pelvis on mother and child

1. If the impact on the mother is a narrow pelvic entrance plane, which affects the exposure of the fetal exposed part, it is easy to cause abnormal fetal position, high fetal head, and cause secondary uterine contraction fatigue, leading to prolonged or stagnant labor. If the middle pelvic plane is narrow, it affects the internal rotation of the fetal head, and it is prone to continuous occipital lateral position or posterior occipital position. The fetal head is incarcerated in the birth canal for a long time. Compression of soft tissue causes ischemia, edema, necrosis, and shedding, and a reproductive tract fistula is formed postpartum. Premature rupture of the membrane and surgical delivery help increase the chance of infection. If severe obstructive dystocia is not handled in time, it can cause threatened uterine rupture, or even uterine rupture, endangering the life of the mother.

2. Effects on the fetus and the newborn baby The disproportionate pelvic pelvis is prone to premature rupture of membranes, umbilical cord prolapse, leading to fetal distress and even fetal death; prolonged labor, fetal head compression, ischemia and hypoxia are prone to intracranial hemorrhage; birth canal Narrowness, increased opportunities for surgical midwifery, prone to neonatal birth injury and infection. ^[1]

Postpartum Pelvic Floor Recovery Exercise

Pelvic gymnastics can help to strengthen the strength of the vagina and anal sphincter.

1. Horizontal exercise: Lie on the back of the bed with your hips on the edge of the bed, with your legs straight and hanging out. Do not land. Hold the bed with both hands to prevent slipping. Close your legs, lift up slowly, close your body, and straighten your knees. When your legs are raised above your body, support your legs with your hands to lean them against your abdomen and keep your knees straight. Then, slowly lower your legs back to their original position. This is repeated six times, once a day, but it can be continued all year round.

2.Vertical exercise: stand with your legs slightly apart, contract the hip muscles on both sides, and make them close to each other, forming the thighs close together, turning the knees outward, and then contracting the sphincter to move the vagina in the upward direction. After patience Exercise, you can learn to distinguish between vaginal and anal sphincter contraction, improve vaginal relaxation, improve vaginal pinch function, so as to grasp the ability of couples to relax and contract when they are in the same room, and make sex life harmonious and happy.